Hypo-hyperdontia, the simultaneous occurrence of hypodontia and hyperdontia, is a rare dental anomaly, especially in the mandibular anterior region. This case report presents a male patient with unilateral agenesis of the mandibular central incisor (41) and the presence of mesiodens. Clinical and radiographic evaluation confirmed the diagnosis. Due to its potential impact on occlusion, function and aesthetics, a conservative approach was adopted, retaining the mesiodens to preserve arch integrity and support craniofacial development. The case highlights the importance of early diagnosis, thorough radiographic assessment and individualised treatment planning in managing hypo-hyperdontia. Follow-up is ongoing to monitor long-term stability and functional outcomes.
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